OSHA overestimated risk, peer reviewers say
OSHA overestimated risk, peer reviewers say
Docket reopened for comments on reviews
Health care workers’ risk of death from TB has been "grossly overestimated" by the Occupational Safety and Health Administration (OSHA), says Richard Menzies, MD, the head of the Montreal Chest Clinic, and one of two professionals asked to review the risk assessment that underpins the agency’s proposed TB rule. Because of the studies it used, the agency also overestimated risks to workers in one of three general settings — that is, communities with moderate to moderately high prevalence of TB infection, according to Menzies. Last month, OSHA reopened its docket for comments on the proposed TB rule, and also released for the first time two peer reviews of the risk estimate contained in the proposed TB rule.
Menzies says OSHA used overall death rates from TB, which are heavily weighted by deaths among older people and homeless or otherwise very marginal people who typically seek care very late. Age-adjusted rates, by comparison, would have shown much lower mortality in the young and generally healthy age groups into which most health care workers fall, he explains.
Menzies also criticized OSHA for relying on survey findings, saying "that’s always biased and subjective information," and for using poor-quality studies from the United States. "That was okay for estimating community prevalence rates and the like, but they could have found better studies from outside the U.S. to get a handle on long-term risks," Menzies notes.
A second peer reviewer also took issue with the data the agency used. "In general, these kinds of studies are all awful," says Mark Nicas, PhD, a certified industrial hygienist and a professor at the University of California at Berkeley. "They’re all missing a lot of basic information you really need to know. For example, no one tracks the number of TB patients per hour the workers have contact with, the studies rely heavily on self-reporting, and there’s always a problem of making sure things are standardized everywhere."
OSHA makes do with available data
Even so, the "awful studies" were the only game in town, he concedes. "OSHA doesn’t have the luxury of going out and doing their own studies, and nobody else has any better ones. So given that, I think their overall approach was sound."
Nicas also says he found a math error that had gone unnoticed in a succession of peer reviews of two versions of the risk standard, the estimation of which makes up the supporting rationale for having a federal standard for TB. "I found it a bit surprising that no one else had caught it," Nicas says. The error inflates the way risk is calculated, though probably only slightly, Nicas adds.
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